Munchausen syndrome. Problematic diagnosis.
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Biomedical subjects
Publications and source records attributed to J Ananth.
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An uncontrolled clinical study was carried out to evaluate the therapeutic efficacy of clomipramine (Anafranil, Geigy Pharmacueticals) in a group of twenty obsessive-compulsive neurotic patients. Clomipramine proved to be extremely useful in alleviating obsessive-compulsive neurosis as well as phobia. This finding was not secondary to the improvement in anxiety or depression which occurred, as the degree of improvement in obsessive symptoms far exceeded the improvement in the other symptoms.
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Methodological advances in drug assay techniques and their increasing availability have made the measurement of tricyclic antidepressant plasma levels more frequent and even fashionable. Plasma levels of tricyclics have been correlated with diagnosis, prognosis, clinical response, and side effects. But even in the area most extensively examined, the correlation between plasma level and clinical response, the results have been conflicting. Different studies have suggested that there is no relationship between plasma level and clinical response, as well as positive and negative correlations, and even a curvilinear relationship. On the basis of available evidence, it is impossible to define a therapeutic range of plasma levels that will be applicable to depressed patients as a group. For the moment, the problem of finding a suitable therapeutic dose for the individual patient remains of paramount importance. Studies to date suggest the need to take into consideration genetic factors, previous and present use of other drugs, the possibility that therapeutic failure might be a result of too high as well as too low a dose, as well as the possible relationship between high plasma levels and side effects. Also, since for the specific individual, the metabolism of different tricyclic antidepressants is similar, it may be useful to adjust dosages until a therapeutic one is obtained instead of immediately switching to another medication. Finally, although the usefulness of routine plasma level determination remains to be established, this technique may be indicated in cases of intractable depression and remains an important research tool.
Treatment of manic episodes is an urgency because of the lack of insight and excessive psychomotor activity. Over the past two decades various new modes of pharmacological treatment of this condition has been reported. Along with them, biochemical findings in manic patients have been exhaustively investigated. Etiologically based pharmacological treatment of manic episodes will help us therapeutically in improving the condition of the patient and scientifically, to confirm or explore biochemical basis of manic episodes. The new innovative approaches for the treatment of manic episodes need to be applied in treating therapy-resistant patients. Included in this paper are treatment approaches based on norepinephrine, dopamine, acetylcholine, serotonin, gamma-aminobutyric acid and permissive hypothesis, peripheral autonomic imbalance, endocrine abnormalities, electrolyte disturbances, paradoxical response, and cyclic AMP. In addition, use of antidepressants and pyrotherapy is described.
Psychotropic drugs are used frequently for the treatment of emotional as well as other disorders. With usage so widespread, many pregnant women receive psychotropic drugs. Maternal ingestion of these drugs may produce, in the fetus, side effects including withdrawal symptoms. Withdrawal signs in the fetus as a result of maternal intake of opiates, hypnotics, analgesics, and tricyclic antidepressant drugs have been reported. Fetal side effects can occur by maternal ingestion of nuroleptic medications, lithium, antidepressants, anxiolytic sedatives, anticonvulsants, and bromides. The author feels that even though these drugs are generally safe, they must only be administered to pregnant women when absolutely needed, and then under vigilance.
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In our non-blind comparative study, amantadine was as effective as the standard medications, benztropine and ethopropazine, in controlling drug-induced extrapyramidal signs. However, statistically significant improvement was noted a week after all the three medications. In addition, extrapyramidal signs were not completely controlled in most patients even after weeks, even though substantial improvement was noted. This indicates the limitations of the currently available antiparkinsonian medications. Amantadine produced least side effects. Therefore, it may be particulary useful in patients who may not tolerate antiparkinsonian medication with anticholinergic properties. Our clinical finding that two patients with depression improved was rather interesting and needs further exploration. In summary, anamtadine is a valuable addition to our armamentarium of antiparkinsonian drugs. The drug compared favourably with other standard medications. The problem of dissipation of the therapeutic effects over time was not studied in our trial.
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